Peter Josef Safar

Short abstract

The father of cardiopulmonary resuscitation

Peter Safar, a pioneer in critical care medicine and a three-time Nobel prize nominee for medicine, was known as the father of cardiopulmonary resuscitation (CPR).

Figure 1.

Credit: UNIVERSITY OF PITTSBURGH

During the 1950s, Safar designed a daring experiment, one that he acknowledged could not be repeated in later years—he sedated and paralysed volunteers. Then he would tilt a volunteer's head back and thrust the jaw forward, demonstrating effective airway opening. He also proved that a long forgotten manoeuvre, the “kiss of life,” or mouth-to-mouth resuscitation, was far more effective than the then standard chest pressure and arm lift technique.

Safar emphasised that saving the heart and lungs would have little value if the brain were not similarly protected. He promoted cardiopulmonary cerebral resuscitation, or CPCR, which relied on mild hypothermia to preserve cerebral function. He also performed studies on dogs to examine whether profound hypothermia could induce at least a brief state of suspended animation—something that he hoped could prove useful in cases of severe trauma and exsanguination. “Peter believed if you could buy even an hour or two hours to figure things out in the madness and mayhem that happens in these situations, it might buy the time you need to sort things out,” said Patrick Kochanek, director of the Safar Center for Resuscitation Research in Pittsburgh.

Several early studies of hypothermia failed to produce practical benefits for humans, while one sceptic dismissed the more radical field of hypothermic suspended animation as “quaintly fanciful.” But Safar, tantalised by successful animal studies that he began conducting in the 1950s, was not one to be put off and he continued his research. Ultimately, one of his former students reported the results of a small study that was published simultaneously with another study in the New England Journal of Medicine in 2002. Both studies showed improved outcomes in post-cardiac arrest patients treated with mild hypothermia (NEJM 2002. ;346: 549-56 and NEJM 2002. ;346: 557-63).

Safar was equally tenacious in launching organisations and departments to aid critically ill patients. In 1958 he developed what is believed to be the first intensive care unit in the United States. In 1961 he launched the University of Pittsburgh's anaesthesiology department and in 1976 he helped found the World Association for Disaster and Emergency Medicine. In 1979 he founded the International Resuscitation Research Center at the University of Pittsburgh—renamed the Safar Center after his retirement in 1994.

Safar, of Jewish ancestry, was born in Austria. He evaded the Nazis through a combination of subterfuge and assistance from an understanding official who ignored Safar's lineage when filling out his papers for medical school. However, with his Jewish heritage concealed, Safar was conscripted into the Hitler Youth. A flare-up of eczema allowed him to obtain a medical release from duty. Terrified that he would be returned to duty when his eczema cleared, he risked death by smearing himself with an ointment used to test for tuberculosis and inducing a bizarre skin rash. The ruse was successful. Doctors granted him a medical release.

Safar's experiences during the Nazi years had a profound effect on his world view. He worked tirelessly for nuclear disarmament, international law, and world peace through organisations such as International Physicians for the Prevention of Nuclear War and the World Federalist Association (WFA). “He always called himself a world citizen,” said Phil Safar, a lawyer, and the elder of Safar's two sons.

“He saw a connection between medicine and politics,” said Amy A Langham, executive director of WFA's Pittsburgh chapter, where Safar was active. “He knew that injuries to humans caused by war could be prevented through political cooperation. He saw the United Nations as the only organisation that could bring hope to the idea of world cooperation.”

Another tragedy would have a profound effect on Safar. In 1966, while Safar was away at a medical conference, his 11 year old daughter Elizabeth fell into an asthma induced coma and died. Safar became convinced that lay people, not just doctors, had to be involved in resuscitation if lives were to be saved. One year after his daughter's death he designed and implemented the first ambulance service with a physician and volunteers trained in CPR.

Although Safar was a self described workaholic, he had an unusual ability to step back from his own work and keep perspective. “He had a rare combination of genius, elegance, and drive,” said Dr Kochanek. “If a person looked hopeless... he'd be the first to say, `Is it appropriate to give CPR?'” Safar, concerned that the technique he worked hard to teach was being used unthinkingly in every instance of cardiopulmonary arrest, wrote, “CPCR is for the person with a heart and brain too good to die.”

He leaves a wife, Eva, and two sons.

Peter Josef Safar, professor of resuscitation medicine University of Pittsburgh, Pennsylvania, USA (b Vienna 1924; q Vienna 1948), died from cancer on 3 August 2003.